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  CSPAN    U.S. Senate    News/Business.  

    December 21, 2012
    9:00 - 12:00pm EST  

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of eligibility for medicare from 65 to 67. if the proposal is fully implemented in 2014. can i go back? so we assume full of limitation in 2014 of this proposal in order to calculate the full year fully implemented a facts in the current budget window. although most of the proposals to raise the age of eligibility would face in overtime. our study is the first to look at the effects of increasing medicare's eligibility age in the post a ca air. that's important because it to some extent alleviates the concern that tricia mentioned that people who lost their eligibility for medicare would lose access to health insurance entirely. because under the health reform law they would have access to new sources of coverage. so our study also goes beyond some of the other analyses to look at the effects of raising
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the age of eligibility, not just on federal spending and on medicare spending, but also on state spending, on out of pocket costs for the 65 and 66 year 66-year-olds to shift out of medicare. on employer costs, on cost for part b. premiums for people who remain on medicare. on the exchange premiums for younger enrollees, as well as the total health spending a facts of all these changes across all the different players. we estimate about 5,000,065 and 66 euros would be affected if this proposal were implemented in 2014. we assume that all would have coverage from another source if not for medicare although the supreme court's decision to make the medicaid expansion optional calls this assumption into question to some degree. in terms of the distribution of those beneficiaries who are affected by this proposal, as you can see on this slide, 42%
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would be expected to receive coverage from an employer past, from retiree plans and the other half of active workers our spouses of active workers to 20% would be covered by medicaid including those who would have been covered by both medicare and medicaid as dual eligible. as well as those who would qualify because they have become 133% of poverty would qualify for the new medicaid expansion. and just about 40% would receive coverage through the new exchanges. in terms of the effect of raising eligibility age and beneficiaries out of pocket spending, the direction and magnitude depends on a number of factors, including whether people would be covered by medicaid or whether they would receive subsidies for coverage to the exchange. our analysis takes into account all the expected costs that 65 and 66-year-olds would have faced if they were enrolled in
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medicare, including the medicare part b. premium, and premiums for supplemental coverage they may have had, and the out of pocket out of pocket cost of medicare coverage services. didn't expect agreement agreement on sharing other under sources in love medicare. our analysis shows that about two-thirds are estimated to are estimated today, two-thirds of the 5 million cameras there to pay more as a result of shifting from medicare to another source of coverage. on average, about $2200 more. and one-third are estimated to pay less under their new source of coverage than they would have paid out of pocket under medicare. on average, about $2300 more. the one-third who are projected to of lower out of pocket spending include people who would qualify for the medicaid expansion, and those with relatively low incomes who would qualify for a more generous subsidies through the exchanges. the group that we estimate that would pay the most distant as
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the 860,000 new medicaid enrollees, those with incomes below 133% of poverty. but two-thirds are estimated to have higher out of pocket spending include people with incomes above 300% of the federal poverty level, who received either less generous subsidies or no subsidies for exchange coverage. and those with an employer sponsored insurance. the group that there's the largest increase we estimated to be roughly 1 million people with incomes above 400% of poverty, receive coverage under the exchange. so now i want to shift to the impact on federal and state spending and the effects on spending by other payers. net medicare savings were estimated to be about $23.5 billion. this is a savings from not paying costs for the 65 and 66-year-olds who are no longer eligible for medicare, minus the premiums for part b. that those individuals would otherwise have paid.
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in terms of the impact on total federal spending, the growth federal savings are estimated to be just over $30 billion, but federal spending increases eyed about $8 billion from medicaid as the low income 65 and 66-year-olds shifted medicaid coverage, by f. at $9.4 billion to the exchange for subsidies for those who shift out of medicare, and qualify for exchange of subsidies. there's a revenue decline from the part b. premiums that are no longer paid by these 65 and 66-year-olds. so on net our analysis just that federal spending is estimated to decline by 5.7 billion in 2014. in terms of out of pocket cost was estimated higher net out of pocket costs as a result of this policy, partly due to an increase in part d premiums, paid by people ages 67 and older who remain on medicare in 2014.
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this is because you are removing the relatively healthy 65 and 66-year-olds from the medicare risk pool, so that risk pool gets a little bit thicker and costly are on average. and then there's also an increase in the premiums paid by those under age 65 who purchase coverage to the exchange, because we are shifting the lower costs, 65 and 66-year-olds, out of medicare and into the exchange. we estimated employer cost would increase by about $4.5 billion which results from employer plans becoming primary rather than secondary payers. wrapping around medicare. now that medicare is no longer the primary payer, they become a primary. we estimate total premiums could increase as result which increase costs for employers and retirees. each are expected to be about half of a higher premium total. state medicaid spending is estimated to increase by just under a billion dollars in 2014.
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this is mainly a combination of increased spending on medicare part b premiums for the dual eligibles ages 67 and older, as i mentioned raising the age of eligibility assessment increase the part b premium for medicare enrollees. interstate saving associate with not paying medicare premiums for those ages 65 and 66 who would have been tools. so when you add it all up, the bottom line from our analysis is estimated that federal savings of $5.7 billion a net increase cost of $11.4 billion to other payers for a net result of $5.7 billion in increased costs over all. so to sum it all up we estimate that raising the age of eligible for medicare as fully implement it in 2014 would reduce medicaid spending, although less than previously estimated because of the new cost of providing subsidized coverage to those who qualify for the exchange coverage, or medicaid. it would reduce out of pocket cost for 65 and 66-year-olds of
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relatively low income while increasing costs for others, including the majority of those aged 65 and 66 with incomes above 200% of poverty, adults younger than age 65 and seniors and people with disability who remain on medicare. so our analysis really underscores the importance of carefully assessing the distribution will ask of medicare reform proposals by breaking the age of eligibility, clearly savings to the federal government is an important goal in current discussion but within health policy circles of course a lot of attention is also being focused on keeping our eyes on the prize alert health care spending over all, which our analysis suggests is not achieved by raising medicare eligibility age. so with that i will turn it back over to ed. >> thanks very much, julia. now we will turn to gail wilensky who has no slides we don't have to worry about getting -- she is a senior fellow at logic hope.
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she's all -- project hope church is also a former administered a former health policy adviser to the president come one of america's most respected health economists and i'm pleased that a frequent contributor to aligns programs are gail, thanks for joining us today. >> [inaudible] >> you should see a red light. >> thank you, ed. i'm delighted to be here but i'm going to try to make four or five points quickly, and i look forward to the discussion. i found the analysis that we just heard that kaiser family foundation has done very interesting in looking what they see as the likelihood of what would happen if the increase in eligibility were to be instantly implemented in 2014.
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although as has been indicated, that is generally not the proposal. and while i appreciate the qualification, i think it's important to understand there was one assumption that was never made, and that is that they would be any behavioral change as a result of the change policy. for many of us who support the notion of increasing the age of eligibility for medicare, and i'm going to qualify in a minute, it would be within the context of part of a set of fiscal policies that need to be enacted in order to encourage individuals to change their vision of appropriate retirement age, from something first enunciated by bismarck in late 19th century, to something that is more reflective of the increased longevity that has occurred, and that needs to be consistent with the way to make it easier for people to stay in the labor force longer.
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obviously, this is something that would occur over time and not indeed be instantly put into effect in 2014. you have in your packet a piece i wrote earlier in the year where i articulated what i thought were emerging elements of bipartisan agreement of ways to try to reform medicare, oh, what a difference an election makes. it was earlier in the year regarded by none other than the president as an element that should be considered as a way to try to reform medicare. times do change. it makes it less likely now with the political shift, but i think it still remains an important issue to consider. and let me explain what the pros and cons as i see. first, it is not a plan to see a
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medicare. yes, the safety five and 66-year-olds are healthier than the average medicare individual, cbo estimates says as you've heard, range somewhere between 113 and 130 billion over 10 years, depending on when the estimates have been made. nonetheless, as a part of a strategy to try to encourage people to stay in the labor force longer, but not the only one for sure, it makes sense. why is that? well, as you know there's been a substantial increase in longevity. wins osha's goodie was adopted in 1935, neither men nor women lived to 65. when medicare was adopted in 1965, men were living slightly more than 65, less the 67, and then to almost 74. we are now talking high '70s
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for males and into the '80s for females. that is not uniform. i understand. i'm speaking tomorrow at an nih conference on finding ways to reduce disparity. but it is clearly true in general. and what we need is to try to find ways to try to encourage people to participate in the labor force longer, not only for our sake but for their sake as well. being contributors to rather than takers from the public. it will require a number of changes. this one if done carefully could be one such component. second is that medicare has a serious long-term problem. one that is not likely to be resolved only by increased financing. as most of you know there will be a doubling of the population when the baby boomers finished
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retiring. that is associated with moving from all the entitlement spending of about 10% now the more than 50% of the gdp in 2030. that is an indication of a very serious change that we're going to have to look going forward here now, some people have commented that medicaid spending, at least on a per person basis look at over this decade, is looking pretty good to the growth in medicare spending has been -- beneficially projected at about the rate of the economy. but, of course, we all should recognize that what we are seeing are the results of projections that incorporate medicare's paying the providers of services less, not medicare
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costing less. it's a really important distinction. paying less isn't the same as services costing less. in fact, it is one of the reasons that the medicare actuary has repeatedly said in public that he questions whether the accumulation of reductions in payment will be able to be sustained because without a real reduction in the cost, it will lead to access problems. and it leads historically reductions in payments have not been sustainable in medicare for that very reason. they are promising changes that could be implemented in medicare result of pilot programs or things going on in the private sector, but right now we need to recognize that what we are observing are reduced payments from medicare, not reduced costs for medicare. so that is an issue that will
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continue to have to deal with. what we really need to consider is how can we implement, if we want to let such programs, in a way that recognizes most individuals can work after the age of 65, although there's an increase in the number of people who are experiencing disability and, therefore, would not be able to work. one is to have a differential allowed to the people who are not able to work because of disability would qualify for medicare as it exists now. to some extent that already would exist by default because of the ssi provisions that allow for people to go on to medicare as a result of disability. there's another interesting concept that speaker emanuel raised last may of talk about whether or not raising the age of eligibility to correspond to
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lifetime wealth is something that ought to be explored. and the idea there is to say that people who have had higher lifetime wealth would be expected to join medicare and perhaps social security at older ages and people who have had little amounts of lifetime wealth, for whatever reason. the issue really is to recognize that the stress that we are going to see going forward in the medicare program, particularly after the end of this decade, even given the assumption that all of the currently legislative reductions in the affordable care act actually occur is going to put enormous pressures on introducing change into the system. and one, as i said earlier, that will be very hard to accomplish simply by raising the financing, trying to decide what those
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changes are, that makes sense. allowing ourselves a little run room so that we could introduce them in a phased way over the course of five or 10 years, signaling people are coming into retirement that they should have different expectations about the program that they will face would be enormously helpful. unfortunately, that has not been our strong point, and as i have been commenting for the last several years, i don't know yet that the country is ready to consider in a major way entitlement reforms right now, or in 2013 more appropriately, for a simple reason. and that's because we don't have to right now. whoever has the fortune, or misfortune, to be elected
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president in 2016, and speculation has already started i've noticed, is not going to be able to delay it any longer if we go that far because of the a team that it affects of baby boomers on retirement. but it sure would help if we could make up our mind about what we're going to do to make medicare sustainable over the long haul, at least the next couple of decades. >> thank you so much, gail. we're going to turn next to david certner, with the legislative counselor for aarp and director of aarp's legislative policy for government affairs. and he does have a slide or two. date is an attorney with a rich background in retirement benefits, among other things and he's been a aarp long before it became aarp. so we have the voice of experience with us. david. >> thank you, and thanks very
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much. first i wanted to start by just on the medicare beneficiary population is because sometimes people think that this is a population that is much better off than it actually is. so it will take a look at this first slide. you will see where beneficiaries generally stand on income perspective, and you can see from this lie that the median income for a beneficiary is basically a little under $23,000. even if you go up to the 75th percentile, so three-course of all beneficiaries with incomes of $40,000 or less, many of those who are above those of us have higher incomes but they are still working and have wage income. a medicare beneficiary is a very modest income population. i think this is important to understand what we are talking about raising medicare eligibility age because raising the age is the very core a
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simple cost shipping so we are asking someone to pick up a lot more cost. one of the folks were asking to pick up a lot more of the costs on to medicare beneficiaries who are 65 and 66 who are already at very modest -- modest levels of income. as you can see from the next slot and beneficiaries also spend a fair amount of their income on health care spending but it's one of the largest cost for seniors. so the typical senior has always been about 17% of their income on health care. and i know in talking with lots of our members and having talking to many members of congress, very few of them will come back and say that what they've heard from the constituent is that people don't think they're paying enough for health care. people are already paying a lot for health care in this country, particularly seniors. so when we talk about it tonight cost should come as critical to remember who the populace watauga, whether incomes are and what they are already spending on health care. another argument that we've heard is what we should maybe make social security and medicare more similar and,
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therefore, raising medicare age makes sense. but, of course, this argument returns no issue on its head and doesn't make sense either. because social security age while it was raised to 67, you can still get access to social security age 62. so anybody who need social security can get access to it with an actuarial reduction. so people who need to benefit don't lose that coverage. they can still get the coverage. so if you're looking to harmonize you would be talking about lowering the medicare age because most people actually claim that social security benefits at age 62. 60 being the age at which most people claim the benefit, so by the time you get to 65 past winter and people have already claimed their social security benefit. so this is a significant difference between social security and medicaid. you always get access to benefits. this proposal would take away coverage for people who would be able to get it under the program. more importantly when you think about sasha security versus
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medicare, part of the reason you're trying to talk about raising the social security age, and this again, this was done back in 1983 and we're still raising the age which gives you a sense of a long face in time that was originally set for this program. still happening almost 40 years later. the key distinction here is that you can delay getting social security if you're still working because you don't need social security. if you're still working and still have income, then you don't need social security. you can put it off until later. but if you delay retirement and are still working, you still need insurance. that need doesn't go away. it's a fundamental distinction. if you're 65 or 66, you still need health insurance. so where does that leave us? that leads us to my final slide which basically shows you, as the numbers we talked about earlier, the difference in costs for somebody was trying to get health care through medicare or through an employer provided
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system, and employer-provided system cost a lot more than medicare. and so by pushing people into a different system, what are we doing? we're accomplishing raising health care costs, not lowering health care costs in this country. and the focus here shouldn't really be on how much the federal government is bent on health care. the really big problem is how much the country is spending on health care. and a generation ago when i started working, we were spending about 10% of the country's gdp on health care. we are about to hit 20% as a nation. so more and more of health care dollars are going, more and more of the nation's dollars are going to health care. that's the big fundamental problem. and by shifting more people out of medicare into a more fragmented, more costly system, we may be saving the federal government money but we are making underlying problem, the real problem worse which is will be spending more money on health care. and i think kaiser for the
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numbers on this because i think they showed really what's happening here by pushing people into different programs, if you push them into medicaid or the employer-provided system, or by the way didn't talk about the fact cbo estimates about 5% or so would be uninsured, and not have coverage at all. that we're pushing people into more costly system. and so we are not saving the country any money at all. in fact, we are costing the country money. we are raising health care costs in this country and would you think about the big debate we just had over health care, regardless of whether you support health care reform act, i think most people support the underlying goals of the bill, which where we want to try to improve coverage in this country while lowering health care costs. and this proposal does exactly the opposite. it increases the number of people who don't have insurance and it raises overall health care costs. so it's a very simple and bad
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solution. and it's actually looking at the wrong problem. the problem is health care costs. we are actually making health care costs worse. and so we reject this as a way to move. now medicare as a program and can certainly be more -- cancer be made more efficient than is today. we think it into a better job with care coordination and with transition between settings. that's way to make health care more efficient, to save money, to make people healthier than to cost less by simply raising the age which simply telling people you will have to pay more for coverage and by the way, some of you will be able to afford your coverage at all, even those who have the exchange is available to them, assuming they are available for subsidy to exchange is still prevent three to one age ready to the people in exchange for 65 for 66 will be paying three times as much as a younger person for health care. so the significant costs that we're shifting onto the population. i go back to the population we
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are talking about, talk about a population who has a median income of $22,000 as kaiser's numbers show the average cost increase for people who will soon increase our $2200. so another 10% of their income will be going to health care. i suggest to you that for those people is not an affordable cost share. and particularly if we're talking about the deficit reduction context, and i think or talk about the fact that is not good health policy in this country, giuseppe raises health care costs so it's not a good health policy. some will argue we need it for deficit reduction purpose but we need to lower the amount of government spin on health care so this is an important policy. but i would ask you, is a right to this group of people, 65 and 66-year-olds, bearing these very large cost, is this the group you think should be airing a huge part? i would argue this is not a particularly fair shepard and of
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this group of people division 10% of their income in addition to health because but it's really not something that they can bear. so for us this is a pretty simple equation but it doesn't make sense as a matter of health policy. it raises cause, it doesn't load the but it increases the number of uninsured. it increases premiums for everybody else remains in medicare because you have now taken the is people and help his people out of medicare. so everybody remain in medicare, doesn't just affect 65 and 66-year-olds, everybody remain in medicare will see a premium increase, estimated about 3% a year. when you move those 65 and 66-year-olds into the private market now you're putting the least healthy into that risk pool and making that risk pool worse, and everybody there will see a premium increase. so end up with higher costs and more uninsured. it's a bad measure for health care in this country. and if we're looking at it from a deficit reduction deficit we're asking people who have named incomes of $22,000 to pick up a huge amount of additional cost. so from either perspective it
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doesn't seem like a good idea. >> i think we got that basic point. thank you, david. our final presentation is, paul dennett, who is a senior vice president for health care reform at the american benefits counc council, american benefits council represents fortune 500 companies that sponsor or administer health and retirement benefits affecting about 100 million americans. paul has also served in senior positions at hhs. he's done a stint here on the hill, and is well-positioned to offer us some comments about the proposal at hand. paul, thank you for joining us. >> thanks, trimming, and thanks very much for the invitation to join you. for those of you who are taking notes i'm going to make three points, and even if you don't, it may just lead healthy to
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understand what disappoints are going. the first point is this what i want to talk about how all employers are not the same. so when we look about the impact on employers, you really have to look behind that in terms of which employers are we talking about. the second point is kind of follows from the first point, which is that the response among employers who of change public policy change of this sort will also very picky won't be the same, different response from different groups of employers. and my third point basically is that context here matters a lot, particularly to the same employers that typically would offer these types of benefits to employees and to retirees. so let's go back to the first point about not all employers are the same. i think one of the major contributions of the study that was done by kaiser family foundation that juliette walked through, two things. one is it's one of the first artist that takes a look at the post health care reform, and
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reminds us that that world changes a lot of the typical analysis that was done in the past about the effects of policy changes and the medicare program, and you need to update all of your assumptions based on how people will behave in a post-reform world. that in itself was a major contribution to the other that was a looks at a distribution a affect of these types of policy changes. well, when you look just at the employer community, i think it's really important to understand exactly where retiree health benefits are. there was a recent study in october 2012 by the employee benefits research institute that found that no great surprise that the existence of retiree health benefits have been declining and you can really marked the decline of retiree health benefits from 1990 which
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was the introduction of the financial accounting standards policy which required employers to account for not just the present year liability for making commitments for benefits to employees, but the whole stream of future liability and discount that back to their liability books in the current year. that had a major impact on employers behavior, because the biggest out year liability that they had committed to was in the health care side. so since that time, retiree health benefits have really been declining almost every year. right now according to the ebri study done a couple months ago, there's only 6% of employers over all that even provide retiree health benefits to employees. if you look at firms with over 1000 employees, now you're beginning to look at where the
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benefit resides, it jumps up to over 30% of those firms. and naturally if you took the numbers even higher, you would really get at the kind of firms in the private sector that still have a retiree health benefit. and those would be in industries like automotive, other large manufacturing, telecommunications, defense and aerospace. outside of some of these industry sectors, very difficult to find a retiree health benefit. and also among small or midsize employers, it's basically now nonexistent. so the effect for most of us who would retire without retiree health coverage from most employers, certainly small or midsize employers, or even large employers that don't offer the benefit, a change in the medicare eligibility age would large be the extent to which that change encourages people to work longer in their job. something that gail alluded to
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earlier. is that a good thing, a bad thing? you know, many employers are looking for older workers to stay in the workforce longer. for many individuals, it's also going to be offset by the fact that again, post health care reform, post 2014, that there will be probably also individuals over age 50 or over age 55 who would no longer face of job loss and will be able to move out of employment because they are not as concerned about staying in until medicare eligibility age and get coverage through exchanges or coverage through another employer. there is more freedom to move around than there had been before. so yes, on the margin it will encourage some employees to stay in the workforce longer because health care typically is subsidized by employers if you remain in the workforce at 75 to
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80% of the cost. and as juliette pointed out, and david also, that many individuals, particularly those above 300% of the federal poverty level won't qualify for coverage in the health -- will qualify for coverage but not for premium tax credits in health insurance exchanges. and so would be better off from just the health care subsidies point of view by retaining coverage through their employer plan. but that won't be true of everyone, and some people will leave earlier than they might have otherwise. secondly, the point here i want to make is that the response among employers will also very. and now we're just talking among those over 1000 employees, employers who offer retiree health coverage to their employees, or their former employees. it's important to note that in many cases there are really two different ways in which an individual who retired prior to
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the age of 65, one of the direction of that coverage will be if you're fortunate enough to have it from their former employer. one is that the coverage ends out of time that they become eligible for medicare. and that's how the contract reach. that's the commitment that has been made. so if the public policy is that at age of eligibility changes and goes further out, so with their health care coverage. however, others are in coverage that says that it ends at the time that they reach the age of 65, since that was a proxy for medicare eligibility age. in that case, those individuals would presumably get coverage on the exchange and till such time as they become eligible for the now delayed college ability take for medicare. either way, but particularly for those employers that would have, that would have policies that are written to say that it continues until the age of
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medicare eligibility, they're going to need time to conform to any change of this sort. they can't just change these things on a dime. but i think more importantly that one of the things that is true among employers generally that offer retiree health from is they're looking for a way to harmonize their strategy between the post-65 retirees and their pre-65 retirees. right now what most employers who offer retiree health do, for those who are medicare eligible, essentially it's defined contribution, a pot of money given by the employer to allow those individuals to shop for health care coverage in exchange just for medicare beneficiaries, which is really about choosing medicare advantage plan, or a prescription drug plan, with finances that are provided by their former employer. employers have already looking
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at possibly doing something very similar to that for their pre-65 retirees, and the availability of coverage through the exchanges may will give them that same ability anyway. in order to move pre-65 retirees into a strategy where instead of the employer sponsoring a plan for retirees, then having them continue on an employer's plan, they will simply provide financial assistance to the plan that an individual may choose on their own, either through a public or these emerging private health insurance exchanges. and in october 2011 study done by powers watson, a large benefit consulting firm, they found only a small percentage of large employers really think that it's a realistic strategy, at least as of 2011, to move employees into health insurance exchanges as they're developing
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becomes 2014. but many more, close to 20 -- 40% of the same employers thought that it was a very viable strategy to do so or retirees. so a change in the medicare eligibility age may well hasten the changed from being a defined benefit plan sponsor for retiree health among employers to more of a defined contribution strategy, again, something that employers all are ready doing for the post-65 retirees in many cases there and then finally the point that content matters, and we've heard a lot about that already from the rest of the panelists. this will be a change in all likelihood that comes up in isolation on its own. we already know that it's being discussed as part of the negotiations between the speaker and the president, over possible ways to avoid the fiscal cliff. large employers are very
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actively are encouraging those negotiations to succeed. it's a very important from the health of the overall economy that the succeed. or it could come up as part of entitlement reform, which gail thinks may not occur until 2016 or beyond. it could come up sooner, or possibly even as part of a broader negotiation over tax reform. so you really have to look not i think just at the possibly of a change in the medicare eligibility age, but the broader context in which that change could come about. >> thank you very much, paul. get to the point where we can hear your comments, hear your questions. there are green question card you can fill out and hold up. someone will bring it forward. there are microphones on either side of the room that you can line up behind to ask a question. and i'd know tricia has been scribbling question been scribbling questions right or
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left as we're going to the presentation. do you want to start us off? >> sure. one of the ideas that gail mentioned that has been put on the table is one by dick in the manual that would apply lifetime earnings test for the wealthier people would pay, would have a delayed eligibility age pics i guess my question as a former administrator involved with social security and medicare and irs may be, what's involved in making that happen? and do you think that's a viable option? and then, what would happen to the savings that would be associated with that? >> i haven't seen his proposes a defined lifetime earnings, anything that goes be on current income, which the irs is very good at calculating becomes very
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complicated in that it attempts to define wealth, including complicated -- something that looks at lifetime earned income would not be particularly complicated because that is already available to social security, and could be calculated. so it would depend very much on how it is done, and how it is phased-in. any of these changes are assumed to be phased-in because it's unfair to change the rules drastically for people who are into retirement are very close to retirement. it is really a say doing to people are into labor force that no surprise to many of them if you ask them their intentions, that the entitlement as they have existed are going to change
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for them, and the sooner we can decide what that package looks like so that they can plan their response, the better off we will be. it's really, again, if you assume no behavioral change, this doesn't look particularly attractive. it is all about trying to put together a package of fiscal policy that begin changing the expectation that a number that would somewhat arbitrarily have chosen in the late 19th century, and that remains pretty irrelevant either through the starting of medicare as an age is no longer irrelevant at all, and with every expectation that we will continue to see increases in longevity, very long periods in retirement as we now define it. >> i think it is worth adding to that, that you're talking about
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medicare being based on lifetime income. i think it ignores the fact that medicare already is very heavily income tested. obviously, there's no income cap right now on the payroll tax cap. so you pay payroll tax based on all your income. there's an income related premium for part b. is an income related premium for part d to give a portion of your soul security tax goes to medicare. now there's additional tax on unearned income above $250,000 that goes to medicare. so medicare is a heavily income related program right now, and, in fact, i can't imagine people on the higher into getting anywhere close back out of the medicare program as what they contribute to it over their lifetime. >> all right. with someone at the microphone. we would ask you to identify yourself and keep your question as brief as you can. spent yes. bob, british medical journal. most of the talk has been about
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the impact upon the federal budget and balancing one pocket versus another. what analysis has been done on, say, on exchanges, on the impact of the employee ability of seniors if and employer has to carry these additional costs for an extended period of time? .. >> suggest that extending the medicare eligibility age would hasten the point at which
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employers might not offer coverage at all. what i was trying to indicate earlier is that for the vast majority of employers outside of industries where retiree health might be highly concentrated, the effect of the medicare eligibility age would be that at the margin there'll be some employees that would continue in the work force longer because the subsidies they receive from their employer for health insurance would exceed the subsidy that they would exceed if they got it on their own through the health insurance exchange. indeed, they might not qualify for one at all. but it could also be offet by individuals -- offset by individuals who go out and do independent consulting or work for a nonprofit with they don't -- where they don't provide coverage because they can now get it through health insurance exchanges. postreform it eliminates one of the reasons that you had older workers remaining until medicare
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eligibility age which was the concern that they couldn't get coverage through any other source. now it becomes an affordability question since it will be available through the exchanges. >> dave, do you want to talk about the consumers? >> well, i think we just heard a little bit about what, you know, the consumers will end up going into different pots, and i think particularly from our perspective we know that's just going to cost the individual a lot more, perhaps a couple thousand dollars more. and that, of course, will lead to the fact that some people just simply won't be able to afford it, and we'll end up with hubs of thousands -- hundreds of thousands of more unensured at the ages of 55, 56. many of them, and we hear from them all the time, are just hanging on until they get to eligibility age hoping they won't have a major event. and, of course, we know what happens to people who don't get the health care they need, they
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end up getting onto the program much sicker and costing the medicare program even more. so i think it's pretty clear that when people have coverage, we can keep them healthier, and we can do something to save sos costs in the long run as well. we just saw the cbo do a study just this past month on the prescription drug benefit with a, basically, rescored the program as costing a lot less because they discovered that, basically, when people are getting the medication that they needed, the health care costs tended to be a lot lower x. so the score went down for the prescription drug benefit. i think you'll see the same thing here. the more uninsured you get, the more costs are being shifted off onto somewhere else and people are getting each sicker. >> but that is the point now that you have the aca, that you can have this discussion in a way that was much harder to have before. it is really a way of saying for those who are able to continue working, can we begin to
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reorient the expectation for the next generation which is what we're talking about, recognizing that for people who are in that pre, now premedicare age, they will no longer have to postpone taking care of health care because they, in fact, have an option. so it is why this discussion takes on a whole different tone as a result of the affordable care act having been passed. >> i mean, i would say we have options, but we don't know if they're affordable options, and that's really the big difference. >> al milliken, am media. what can we learn from other countries? i'm wondering if any of you have studied the health benefit programs elsewhere, and do any have comparable insurance programs, and what has been the experience in other nations? >> most of them are struggling mightily with the promises they are made which encourage people to e retire even earlier tan
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they do in the united states -- than they do in the united states and are finding themselves in very significant fiscal problems. france has to be the poster child, although maybe greece, i guess, would take number wunsch. >> but we do know that the u.s. spends a larger percentage of its gdp on health care than any of the other developed nations by a fairly significant amount. so really tackling that underlying issue of what percent of our economy is going to health care in general is really the key issue. and we should be focused on that, i think, much more than the federal government's portion of it. and in this case where you have a proposal that would actually increase the share of gdp going to health care is taking us in the wrong direction. >> that is assuming that medicare spending equals medicare costs and, again, as somebody who actually ran the program, i'm not assuming that. >> you want to do that one?
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sure. >> dade, this one is definitely for you specifically and aarp. the question is this: what scoreable savings proposals does aarp support for medicare beyond just better care coordination? does aarp support means testing, combining parts a and b cost sharing or medigap reforms or anything else? >> i think it's important to remind everybody that we recently had a large health care bill called the affordable care act which included $720 billion of medicare savings which i'm sure many of you heard throughout the year as both candidates talked about it. so it's not as if we have not contributed a significant amount of savings in medicare already. we still think we can do more in terms of medicare to make the program a more efficient, less wasteful, to focus more on quality of care. there are a number of strategies around that, there are no silver
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bullets. these just don't apply to health care -- i mean, to medicare, but to health care in general. and it is really about making the health care delivery system more efficient. and that means a better job of care coordination, a better job of transition between settings, a better job of using evidence-based medicine, a better job of using health information technology. certainly going after waste and fraud can help. we know there's waste and fraud in the medicare program. but these are all different strategies to make health care more efficient and save money as opposed to the conversation we're having here today is how do we shift cost to another payer. we need to move away from that kind of a conversation and get to a conversation about how do we lower overall health care costs, not just how do we shift costs and in this case shift costs and make the shift even larger than the amount we're saving. >> okay. i've got a question here that sort of tickles my bones because it channels my old boss, claude pepper. though some employers value
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50-plus-year-old workers who question their rights, many others offer incentives to reduce their older work force and/or are reluctant to hire workers 50 years and older. could the panel speak to the effect of this dynamic on a potential increase in the medicare eligibility age? >> as many of you know, there is an expectation of problems stemming from the baby bust generation and lower cohorts entering into the labor force in the future. many have thought the potential for having olderrer workers be -- older workers be increasingly regarded as valuable is highly likely, and one of the questions it has raised is can the federal government help begin to craft a set of fiscal policies that recognize the increased
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flexibility that many older workers will want and to try to make accommodations. i'm -- because of how long i've been doing this, i'm finding it hard not to think sounds haunt ingly like the questions posed about whether or not employers would hire women during child-bearing ages that came up in the 1970s and how would they make those accommodations. and both the additional demand for such individuals in the labor force and the willingnesses for working women to continue, women to work has now made that rather -- that seem rather quaint and old-fashioned. and i suspect over the next decade as we come out of our current supply of workers and go back to a normal period, older
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workers will become increasingly desirable, and employers will have a lot of reason to try to keep them in the labor force especially, um, if we can make it a bit easier for them. >> and i think we would certainly agree. we would like to encourage people who can work to work longer. but i, our observation at the current time is that employers, demand for older workers, and there has been an uptick in the number of older workers over the last 20 years, but the demand is usually for higher skilled which tend to be better paid workers who employers demand to keep or maintain in the work force and not as much so for lower skilled, lower paid workers or. and an interesting point that goes along with that is if you look at increases in longevity, you will see a very dramatic increase in differences between longevity in people who are higher and lower incomes. the significant gains have really been made among higher
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income individuals and particularly at the lower end, longevity gains of the last generation have been very flat. >> paul, you had a comment? >> i would just build on the comments from both gail and david that i think we are seeing a shift for employers valuing older workers. that's, you know, definitely been something that i've seen over the past 15 or 20 years, too, that there's more recognition of the importance of maintaining your talent for longer periods of time. and if anything, one of the first things i think that employers identified as a concern about the availability of subsidies, subsidized coverage in health insurance exchanges is that it might encourage some of the workers who they want to remain in the work force longer to leave sooner than they might, than they might otherwise. so i think that's just one of the realities. and i think as i started out with my comments, i think one of
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the really big contributions that juliette and the kaiser family foundation in general did with their study of really being one of the first that starts to look at the whole world and ask questions of, you know, how does this analysis of public policy change once you factor in the enactment of the affordable care act and its implementation in 2014. >> okay. this is a question for juliette. so the kaiser study estimates, they estimate spending based on full medicaid coverage, everybody who is eligible for medicaid, it's assumed that 100% would get coverage. so there are questions both about coverage and costs. now that the study is done and we know it's going on in the real world, what are the more likely effects on coverage, and what are the more likely effects on medicaid costs? >> okay o. so i'm going to broaden this question a little bit to talk
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about the effects for all coverage sources. so we assumed, as i said, that everybody who lost eligibility from medicare would take up another source of coverage depending on their access to other sources such as employer coverage or their incomes which might qualify them for subsidies or for medicaid coverage. so, um, first let's take this question of the individual mandate and premium subsidies in the exchanges. there have been questions raised about, um, what happens if people 65 and 66 don't have medicare, can they qualify for these. um, so there's no mention of a specific age for qualification, for subsidieses, for exchange coverage. so presumably, if people didn't have access to medicare, they could depending on their income qualify for whatever subsidies they were entitled to. it's a different story for the medicaid expansion.
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the aca specifically does limit, um, eligibility for the new medicaid coverage to people, um, under of 65. so presumably there would need to be a statutory change if the medicare eligibility age was raised to 67 or even higher, um, that provision would need to change to enable people, um, to qualify for the medicaid expansion. the in states that don't expand medicaid, those adults with incomes between 100% and 133 -- 138%, excuse me, of poverty would be eligible for subsidies in the exchange, um, and they would be subject to the mandate. but, um, for people with income below 100% of poverty in states that do not opt for the medicaid expansion, um, they would not be eligible for medicaid or subsidies in the exchange because the law limits those to people with incomes 100% and
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above. however, um, having spoken to my colleagues at kaiser about this issue who have followed this issue more care my than i have, um, they have of said that secretary sebelius has said that, um, these individuals would not be subject to, um, any of the mandate penalties if live inside a state -- if they lived in a state that did not expand medicaid and they fell into this coverage gap. >> but then would they be uninsured? >> that presumably would be the -- >> and so the question from, the questioner really wanted to know do we know how many people could potentially be uninsured? >> um, well, we don't really have, um, an estimate, um, since we didn't factor this, um, our analysis was conducted prior to the supreme court's consideration of the case and the supreme court's decision. um, but i believe there was another analysis done of this issue, i think, by the -- >> center -- >> center for american progress? >> center for budget and policy
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priorities maybe? >> i'm not exactly sure which, but there's been some recent analysis of this question looking at numbers, um, potentially for those individuals who are living in states that have, um, expressed a lack of interest in expanding their medicaid programs. >> okay. so while i have you at the microphone, there are a few other technical questions. one is we assumed 100% federal payments on medicaid -- >> that's right. >> -- because it was implemented in 2014, and some have pointed out that there would be effects for states. could you explain that in. -- that? >> well, the state contribution is initially zero. the 100 percent federal share is until 2017, i believe, and then it phases down the 90% over the next few years. so states would pick up a slightly smaller, i mean, the effects that we found were net spending increase for states of $0.7 billion, so not a huge number at least in the year of our analysis, but there would be
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a slightly, that would be a slightly larger number in the later years of this proposal -- >> and we're going to break away from the last few minutes of this program. you can watch it, of course, anytime you'd like on our web site at c-span.org. we'll take you live now to the national cathedral here in washington d.c. you see a picture there where a memorial service is going to be held shortly for the late hawaii senator danielle inouye. daniel inouye. president obama, vice president biden and veterans affairs secretary shinseki are kennelinged to pay tribute. -- scheduled to pay tribute. rear admiral barry black scheduled to perform the sermon. following a memorial service for members of congress, we see senator dick durbin on your screen. the senator died of respiratory complications mold, he was 88 years old. senator inouye returns home the
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hawaii on saturday. a public service will be held at the national memorial cemetery of the pacific on sunday before he's laid to rest in his home state. we're going to watch and listen now, live coverage on c-span2. ♪ ♪ [inaudible conversations]
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[background sounds] >> i am resurrection, and i am life, said the lord. whoever has faith in me shall have life each though he die -- even though he died, and everyone who has life and has committed himself to me in faith shall not die forever. as for me, i know that my redeemer lives and that at the last he will stand upon the earth. after my awaking, he will raise me up, and in my body i shall see god. i myself shall see, and my eyes behold him who is my friend and not a stranger.
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for none of us has life in himself, and none becomes his own master when we die. for if we have life, we are alive in the lord, and if we die, we die in the lord. so then whether we live or die we are the lord's possession. happy from now on are those who die in the lord, so it is says the spirit, for they rest from their labors.
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>> forward, march. [background sounds] >> as dean of washington national cathedral on behalf of the bishop of washington, i welcome you to this service celebrating the remarkable life of senator daniel inouye. washington national cathedral serves as a place of gathering during times of sorrow. today's event combines a mixture of both. it is our great privilege to host so many distinguished women
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and men gathered today to say good-bye to a great leader and public servant. we all come together today from a variety of faith traditions. whoever you are and wherever you find yourself on the journey of faith, we hope that you will fully join in as we listen and sing and pray in thanksgiving and remembrance for this extraordinary man. ♪ ♪ ♪ ♪
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>> the lord be with you -- >> and also with you. >> let us pray. o good of grace -- o god of grace and glory, we remember before you this day our brother, daniel. we thank you for giving him to us, his family and and friends, to know and to love as a companion on our earthly pilgrimage. in your boundless compassion, console us who mourn, give us faith to see in death the gate of e eternal life so that in quiet confidence we may continue our course on earth until by your call we are reunited with those who have gone before through jesus christ, our lord, amen. >> a reading from lamentations.
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the steadfast love of the lord never ceases. his mercies never come to an end. they are anew every morning. great is your faithfulness. the lord is my portion, says my soul. therefore, i will hope in him. the lord is good to those who wait for him, to the soul that seeks him. it is good that one should wait quietly for the salvation of the lord. for the lord will not reject forever. although he causes degree, he will have -- grief, he will have compassion accordance to the abundance of his steadfast love, for he does not willingingly afflict or grieve anyone. the word of the lord. >> thanks be to god.
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[background sounds] [background sounds] >> irene, kenny, members of the inouye family, all of us express our deepest condolences for your
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loss of this good and great american. president obama, vice president biden, president clinton, distinguished members of the congress, others who have gathered here today to honor the legacy of daniel k. inouye, this morning we celebrate the well-purposed life of a patriot, an american patriot, a life defined by courage, by service to country, by sacrifice for others. soldier, senator, statesman, but down deep always a patriot of enormous resolve and principle. this is a compelling story of what it means to be an american. dan inouye had a profound impact on so many lives, including
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mine. his extraordinary accomplishments are the stuff of legend. battle tested in world war ii, despite severe wounds prevailed in combat, recipient of our nation's highest award for valor, the medal of honor. distinguished senator from hawaii, president pro tem of the senate. his life also exemplified the qualities most revered by his community; quiet humility, respect for others, standing on principles that matter, family, service of -- service to community. a mod man who was assertive in doing what was right. when america was plunged into the crucible of world war ii, nowhere was the attack on pearl harbor more keenly felt than in
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the japanese-american community. it's difficult today to recall the full intensity of fear, of confusion, of suspicion, of recrimination, even hatred that emerged in the days and weeks and months following that surprise attack 71 years ago. and despite the clear injustice in evicting and relocating so many in the japanese community, second generation americans of japanese ancestry demanded the right to defend this country in the time of war like other american citizens. and to our country's credit, their voices were heard, leading to the creation of all knee say units commanded by caucasian
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officers. courage, prowess in battle, trust in one another and determination made these units legendary. the 100th infantry battalion, the 442nd regimental combat team, the military intense service, the mis. these were not just good units or unique because of ethnic home yes knew today, they were premier fighting units, among the best in u.s. history. the soldiers of the 442nd regimental combat team, the go for broke, served with such distinction that 21 of them were awarded the medal of honor. no other regiment in u.s. army history has this distinction. given size and length of service, their legacy is a drum beat of loyalty, of courage, honor, dedication and sacrifice. dan inouye served in the 442nd at an infantryman, enlisting in
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1943 at age 18. within a year he was promoted to sergeant. his performance in combat led to a battlefield commission of second lieutenant in 1944 at able 20. less than a year later while leading his platoon in an attack on enemy machine gun positions, he was grievously wounded and permanently disabled. his actions on 21, april, 1945, in italy were a towering example of strength, of stamina, courage and determination. for which he received one of the 21 medals of honor awarded to go for broke soldiers. dan inouye and other veterans returned from war having achieved something monumental, something, as we say, larger than themselves. and they sensed they had earned the right to take larger roles
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in their communities. they also came home tolerant of views and politics different than their own, a sentiment born of the intolerance they had experienced after pearl harbor but more keenly felt after the horrors they witnessed in liberating dakow. and they understood the importance of good citizenship, of fair play, hard work, of respect for others and for other flag. for our flag. i had relatives who, like dan inouye, served in these storied units. characteristic of them all was rarely if ever speaking about what they had done in the war. and from them my generation learned to find virtue and humility and a nobility of hard work and the value of family and the can confidence that we -- and the confidence that we in america could achieve anything. they taught us to hope and to
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dream and then to do something about it. dan inouye's service helped remove all doubt about the citizenship and loyalty of all americans of japanese ancestry. that is the legacy he and his generation bequeathed to me and mine. it influenced the way i was able to live my life. i would never have had the opportunity to serve as the chief of staff of our army had he and the others not purchased back for me in blood my birthright to compete fully without any question about my loyalty. this morning i salute a friend who was more than heroic in battle, more than strong enough in enduring the terrible wounds of war, more than determined in overcoming injustice and more than generous in sharing his
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enormous gifts with me and with others. dan inouye and the men of these legend dare units -- legendary units sacrificed so much to give us all the opportunities we have. there is no great -- there is great comfort for me in these reminders as we often say we all stand on the shoulders of those who came before us. and i, i have had the broadest of shoulders to stand on. aloha, senator. aloha and mahalo. thank you. ..
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>> mr. president, mr. vice president, lovely irene, as tragic events in recent days remind us, often when death visits, it comes too soon. a plane crash takes many from us, a baby drowns, cancer deprives us of a sibling or a
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friend, an automobile accident steals away a child, lives are cut short, dreams denied. often, death is so troubling. we ask why? why him? why her? why now? although i wish i could answer those questions with authority, often the why of death is a mystery. in the case of senator daniel inouye, there is no mystery. although there is sadness, there is no regret. e cleez yays tis, second chapter, third verse tells us to everything there is a season, a purpose under heaven, a time to
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be born and a time to die. it was daniel inouye's time. senator inouye lived a full and productive life. he was 88 years old when he died, and he lived each of those 88 years to its fullest. he was a war hero, a decorated soldier who left the innocence of youth, most of his right arm on an italian battlefield defending our nation's freedom even as that nation questioned the loyalty of patriots who looked like him. he was a healing hero, an example of the resilience of the human body and human spirit whose resolve to life -- live a life of service was hardened, not broken, from 21 months of recovering from his wounds in an army hospital in michigan. he was a legislative hero, a
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progressive democrat who would never hesitate to corroborate with a republican colleague for the good of his country. in 1968, when the country was divided by racism and war, he calmedded the nation's nerves with a keynote address before the democratic national convention in chicago. daniel inouye advocated for the rights of all americans regardless of the color of their skin or where their parents were born or what their religion was. he was the first chairman of the senate select committee on intelligence. he served as distinction as the chairman of the commerce committee and appropriations committee. during his time as chairman, he turned a formally neglected committee into a powerful voice for native populations across this great country, and remarkably, dan served for more than 34 years with his best
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friend, a late republican senator ted stevens from alaska on the subcommittee. their friendship and working relationship stands as an example of the remarkable things that two senators can accomplish when they set political party aside. together, they were a formidable force in support of this nation's men and women, working to ensure soldiers, sailors, marines, and guardsmen are the best trained and best equipped in times of peace and times of war. senator inouye also servedded as a member of the watergate committee and chairman of the special committee investigating contra affairs. whenever there was a difficult job to do, whenever we needed a noble man to lean on, we always turned to senator daniel inouye so it should come of no surprise that danny died as he lived with
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great dignity. this is no urban legend. the capitol physician said he used to watch people die, but never with such dignity. irene, his lovely wife, talked about the event. chaplain black, security officers who were there with him minutes before he passed away, before he dieded, he shook the hands of friends and crest the family who surrounded him. he thanked the doctors. he thanked the nurses for their care and attention. he thanked his security detail for the careful protection over the years. dan inouye wrote notes detailing his last wishing minutes before he passed away working until
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mere moments before his death. he told his wife, irene, that he would appreciate my speaking before you today, a gesture that touches my heart more than words that i can express. then he said aloha and quietly joined the lord. he had faced death many times, especially during that awful war that he was fighting in. he would often tell us, told me on many occasions, that during his life, he had just been lucky. he always said, just lucky, but dan inouye was not lucky. dan inouye was a blessed man. he had work to do here morning us -- among us, and he stayed until that work was done. as we're always told in the chapter, there's a time to every purpose, and this was senator inouye's time. the 24th psalm asks who ascends
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to the mountain of the lord? who may stand in his holy place? the question's answered the one who has clean hands and a pure heart. that is daniel inouye. a man with a pure heart, a man with clean hands. during the 1968 convention that i just talked about, dan taught the nation that aloha means not just hello, not just good-bye, but it also means i love you. aloha was dan's last word on earth. i say to my friend, danny, aloha, i love you, and good-bye until we meet again.
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♪ >> irene, ken, mr. president, mr. vice president, america has just been through some very painful days, and, mr. president, we're all grateful for giving voice as you have to our agony. as senator reid has said so
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eloquently, dan inouye lived a full, long life, and so it is our great honor to come here to celebrate it. i am grateful that so many of his colleagues in the senate and both parties, leaders and members of the house and the administration and especially the members of the diplomatic core have come because i hope in this short service we can capture the character and contributions of one of the most remarkable americans i have ever known. you know, it is difficult to be in politics and be courageous
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cut being sanctimonious and difficult to be a gallant man in politics without seeming pompous. it is difficult to constantly reach out for common ground without wondering if you have left your principles behind. dan inouye did all of this and more. those of us who knew him can be grateful for so many things, for hillary and me, he was first and foremost a friend, an adviser, something that both of us will cherish forever. i thought i knew a little bit about hawaii who i carried the state twice, and i went back one
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day, and he said, you know, you have not paid enough attention. they have a distinct community here, and i said, well, senator, what do you think i should do about it? he said, i know what you're going to do about it. there's a festival todaying and you're -- today, and you're going in two hours, and i did. when hillary became a senator, he was so hopeful to her in trying to be a responsible member of the armed services committee because of the concern they had for national defense. i never will forget it, and then he was your friend, he didn't care whether the sun was shining or the storm was waging. he didn't care if you were up or down or sideways. he was just there. it is almost impossible now to find someone who makes a life in
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public service, who seems literally every day to be totally oblivious to whether he gets one line of press coverage, but then all of the sudden when the country is down and out, and when we are on the ropes and had to be big, when we were going through the agony of watergate or iran contra, reorganize the intelligence services, or all of the other things he did, the speech he gave in chicago which harry referenced, there were people rioting in the streets, kids getting their heads beat in, there was dan inouye telling us what we needed to know. i am so grateful for him for many things. i am grateful that i had the chance to put around his neck the medal of honor given to him
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and 21 others almost 50 years too late. it meant a lot to me because as he knew, my native state had two of those japanese intournament camps, and i was grateful that he never tired ofcepsing when the moment of come to say what needed to be said. think of this, ten years ago this spring, on the big island, senator inouye gave a commencement speech barely two years, not quite two years, after 9/11. he talked about the future of america and the nature of american's pay tree -- patriotism, a man who gave so much, a man whose patriotism
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could never be questioned, said this, something we should all remember and be grateful to him for. patriotism is defined as one and devotion's to one country, but oftentimes it takes as much, if not more courage, to speak out against our government. it is that love of country that compel some to speak out and oppose action. the ability to criticize and question our leaders is at the essence of democracy. if we do not permit dissenting views and those who confront and bruise our collective conscious, how much longer would we have had slavery? how much longer would the vietnam war drag on? would japanese-americans in world war ii still be awaiting? i hope mistakes made and suffering made upon japanese-americans 60 years ago will not be repeated against
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arab-americans whose loyalties are now called into questions. their profile is drawn to what the enemy looks like. let us know repeat history. he was a wise, a good man. the reason he could be courageous about being sank -- sanctimonious and generous and old-fashionly gallant without seeming pompous, the reason he was friends across the aisles and find compromise without sacrificing compromising principles is because that is who he was, a whole person united by his parts. they blew his arm off in world war ii, but they never, never laid a finger on his heart or
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his mind that he gave to us for 50 years, and that every single citizen should celebrate. ♪
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♪ ♪ >> irene, patty, jennifer, ken, and jessica, thank you for the honor of being able to say a few words about a great man who
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befriended me throughout my whole career. danny inouye, as i was listening to others speak, i thought about how the fact that every high point and low point in my career since i announced for the senate as a 29-year-old kid, your husband, your father, your brother was there for me. from running an impossible race, to coming to delaware to being there when i didn't want to come to the senate to actually knocking on my door and saying you're going to run for president, could i be your national chairman? the impact he has had on not
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just me, but my family jill, and particularly, my two boys. danny's departure marks the end of an era. it's a generation of men and women referred to as the greatest generation who literally transformed america and helped reshape the world, and in my view, among them, danny may have been the most unique, the most whole. robert ingersol could have been talking about danny inouye when he said, "when the world defies fear and duty throughouts the gauntlet down to fate and honor scores to compromise with death, that is heroism." danny was a heroic figure in every aspect of his life.
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as so many have referenced today and always been written about danny since he passed, this is a man who had to overcome prejudice against japanese-americans just for the right to fight, to fight for the country that he loved, and in the process of doing that, he showed such extraordinary valor and heroism, he was awarded the medal of honor. i'm here to tell you that i think his physical courage was matched by his moral courage. i don't know anybody else that i can say that of in my personal acquaintance. his physical courage was matched by his moral courage. danny demonstrated that neither prejudice at home nor enemy
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bullets abroad could keep you from accomplishing the goal which was always about defending his country, but even more importantly, about making his country a better place, always a better place. he tackled one of the most vexing problems at home, and in the reference made by me yesterday in the rotunda and again here today. as a young kid in law school listening to danny's speech at the national democratic convention, seemed like it was the only voice of reason that broke through this god-awful cloud. he stood there with such absolute confidence and certitude in the midst of all that was going on, like what he had to say was just self-evident. how could anybody doubt what he
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said? he was, in my 36 years in the senate, more trusted by his colleagues than any man or woman i had served with. i remember when the church committee decided the intelligence community was out of control, and we needed an intelligence committee. i remember being a part of as a young kid because mike mansfield brought me in to keep me engaged. the discussion was, well, who would head this new committee? it was -- there was no discussion. it was not, like, maybe we'll have so and so or so and so, but it was danny inouye.
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no discussion to the best of my recollection, virtually none. when it came time to deal with watergate, there was that combination of danny inouye, sam herman, and howard baker. the only person on whom there was no discussion was danny inouye. same with the iron contra, and why? why was it so self-evident to every member of the senate that it should be danny inouye? one thing. his miranda -- his moral courage. his physical courage reenforced it, but that was not the reason. no one ever doubted that danny
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inouye had such integrity at his core that he would meet any obligation thrust upon him with absolute steadiness and objectivity. i can want say -- i cannot say that about anyone else, and i served with great women and men, some of whom are here in this magnificent cay tree -- cay three drail. i got to the senate young enough and early enough so i could serve with those so-called legends of the senate. a significant portion of them are still there. even among those women and men, they all knew, they all knew danny inouye possessed that
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intangible thing that every leader longs to possess. that is that he would never waiver from what he thought was right. pretty astounding. it was my privilege just to observe, and in some small way, occasionally participate over the 36 years i served next to danny. danny's power and influence ultimately lay is his character. he earned what every man and woman who ever served in congress longed for. the uncompromising respect, the uncompromising respect and admiration of his colleagues. say to all my colleagues assembled here, can you think of
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anyone who ever, ever, ever, ever questioned danny inouye's integrity? even in the midst of the bitterness that is enveloped the congress over the last several years? the interesting thing was there were men who respected, had great integrity like mike mansfield and others, but i know no one who was both as respected and loved as much as dan in way. love is a word people throw around very easily these days. when people talk about love and danny, they meant it in the way the average american thinks of
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love. i thought there's anyone here who served with him, with danny inouye a week before he passed away, called you and said, can you do the following for me? i doubt there's a single man or woman here who wouldn't have said, of course, danny, i will. my mom had an expression, and she'd say that what is required to have great character is you have to -- she used to use a phrase saying, joey, you are defined by your courage and redeemed by your loyalty. you are defined by your courage and redeemed by your loyalty. no person i ever served with or
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knew since i arrived here had more until or moral courage or ever exceeded danny and his loyalty to those who he respected beyond his family. this may seem like a strange thing to say here, but with the exception of my father, and there's great men and women in this chamber right now, with exception to my father, there's few people i ever looked at and said, "i wish i could be more like that man." he's a better man than i am. that's why i looked at danny, and i told him so. his characteristic way told me my judgment was flawed. [laughter] the truth of the matter is, the truth of the matter is there is
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no one that i ever met. i think the highest compliment a man or woman can give to another man or woman is to look at them and say to their children, to their own chirp, you see that man? you see that woman? there's not a single character trait they have that i do not wish for you. over 35 years ago, i told that to my sons, and i meant it then, and i mean now. i guess that's why my sons call me immediately, separately, from different parts of the world, when hearing of danny's passing. they knew him, and most importantly to them, they knew
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that he knew them. think of that. how important it is to them to be able to say, not just i knew danny inouye; he knew me. it's one of the treasures of their life. danny inouye knew me. it mattered then. it matters now. his passing marks the end of the era, losing one the greatest leaders of the great -- greatest generation and a man who everyone here will miss and a man who taught every one of us in this cathedral something about ourselves we probably didn't know before we met him.
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[background sounds] >> a reading from revelation, and i saw the holy city, the new jerusalem coming down out of heaven from god prepared as a bride adorned for her husband, and i heard a loud voice from the throne saying, "see, the
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home of god is among mortals. he will dwell with them as their god. they will be his peoples, and god, himself, will be with them. he will wipe every tear from their eyes. death will be no more. mourning and crying and pain will be no more for the first things have passed away, and the one who was seated on the throne said, "see, i am making all things new." also, he said, "write this for these words are trustworthy and true, and then he said to me, "it is done. i am the alpha and the omega, the beginning and the end. to the thirsty i will give water as a gift from the spring of the water of life. those who conquer will inherit these things, and i will be their god, and they will be my
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children." the word of the lord. ♪ ♪
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♪ >> to irene, ken, jennifer, danny's friends and former colleagues, it is an extraordinary honor to be with you in this magnificent place to pay tribute to a man who would probably be wondering what all the fuss is about.
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this tuesday was, many many ways, a day like any other. the sun rose. the sun set. the great work of our democracy carried on, but in a fundmental sense, it was different. it was the first day in many of our lives, certainly, my own, that the halls of the united states congress were not graced by the presence of daniel ken inouye. danny was legislated to the u.s. senate when i was 2 years old. he had been elected to congress a couple years before i was born. he would remain my senator until i left hawaii for college.
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even though my mother and grandparents took great pride that they had voted for him, i confess that i was not paying much attention to the united states senate at the age of four or five or six. it was not until i was 11 years old, that i recall even learning what a u.s. senator was or it recommendation steering -- registering at least. it was during summer veighuation -- vacation with my family, a trip to the mainland. we flew over the ocean, and with my mother, grandmother, and sister, who at the time, was 2 #, we traveled around the country, a big trip. we went to seattle and disneyland which was most
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important, and we traveled to kansas where my grandmother's family was from, and i went to chicago and went to yellow stone, and we took greyhound busses most of the time, and we rented cars and stayed at local motels or howard johnsons, and if there was a pool at a motel, even if it was tiny, i would be excited, and the ice machine was exciting, and the vending machine, i was really excited about that, but this is at a time when you didn't have 600 stations, 24 # hours worth of cartoons, and so at night, if the tv was on, it was what your parents decided to watch, and my
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mother, that summer, turnedded on the tv every night during this vacation and watched the watergate hearings. i can't say i understood everything that was being discussed, but i knew the issues were important. i knew they spoke to some basic way about who we were and who we might be as americans. so slowly, during the course of this trip, which lasted about a month, some of this seeped into my head, and the person who fascinated me most was in man of jab these dissent with one arm, speaking in this courtly baritone full of dignity and
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grace. maybe he captivated my attention because my mom explained that this was our senator, that he was upholding what our government was all about. maybe it was a boy who had fascinations about the story how he lost his arm in war, but i think it was more than that. you know, here i was, a young boy with a white mom, a black father, raised in indonesia and hawaii, and i was beginning toceps how fitting in to the world might not be as simple as it might seem. to see this man, this senator, this powerful, accomplished person who was not when it came to what you think a senator
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might look like at the time. the way he commanded the respect of the entire nation, i think it hinted to me what might be possible in my own life. this was a man who, as a teenager, stepped up to serve his country, even after his fellow japanese-americans were declared enemy aliens. a man who believed in america even when its government didn't necessarily believe in him. that meant something to me. it gave me a powerful sense, one that i couldn't put into words, a powerful sense of hope. as i watched those hearings, listening danny ask those
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pierces questions night after night, i learned something else. i learned how our democracy was supposed to work, our government, of, and by and for the people. we have a system of government where nobody's above the law, where we have an obligation to hold each other accountable from the average citizen to the most powerful of leaders because these things that we stand for, these ideals that we hold dear are bigger than any one person or party or politician. somehow nobody communicated that more effectively than danny inouye. you got a sense, as joe mentioned, of just the fundamental integrity that he was a proud democrat, but most importantly, he was a proud american.
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were it not for those two insights planted in my head at the age of 11, in between disneyland and a trip to yellowstone, i might never have considered a career in public services. i might not be standing here today. i understand its fair to say that danny inouye was perhaps my earliest political inspiration. for me to have the privilege of serving with him, to be elected to the united states senate and arrive and one of my first visits was to go to his office and for him to greet me as a
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colleague and treat me with the same respect that he treated everybody we met, and he sat me down and gave me advice about how the senate worked, regaledded me -- regaled me about stories about wartime and his recovery, stories full of humor, never bitterness, never boastfulness, just as a matter of fact. some of them, i must admit, a little off color. i couldn't probably repeat them in the cay cathedral. [laughter] there's a side of danny that -- well. danny once told his son his
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service to the country has been for the children. of all the sons and daughters who deserved to grow up in a a nation that never questioned their patriotism. this is my country, he said. many of us fought hard for the right to say that, and, obviously, rich described what it meant for japanese-americans, but my point is is that when he referred to sons and daughters, he was not just talking about japanese americans. he was talking about all of us. he was talking about those who serve today who might have been excluded in the past. he was talking about me. that's who danny was.
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for him, freedom and dignity were not abstractions, but values he bled for, ideas he sack -- sacrificed for. rights who understood only as someone can when they had them threatened. he had them taken away. the valor that earned him our highest military declaration, a story so incredible that when you actually read the accounts, you think this, you couldn't make this up. it's like out of an action movie. that valor was so rooted in a deep and abiding love of this country, and he believed, as we say in hawaii, that we're one family, and he devoted his life
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to making that family strong. after experiencing the horror of war himself, he felt a profound connection to those who followed. it was not unusual for him to take time out of his busy schedule to sit down with a veteran or fellow amputee, trading stories, telling jokes, two heros generations apart sharing an unspoken bond forged in battle and tempered in peace. in no small measure because of danny's service, our military is and will always remain the best in the world. we recognize our sacred obligation to give our veterans the care they deserve. of course, danny didn't always take credit for the difference he made. ever humble, one of the only landmarks that bear his name is a marine corp. mess hall in hawaii. when someone asked him how he wanted to be remembered, danny
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said, "i represented the people of hawaii and this nation honestly and to the best of my ability. i think i did okay." danny, you were more than okay. you were extraordinary. it's been mentioned that danny ended his convention speech in chicago in 1968 with the word "aloha," and for some of you who visited us, it may have meant hello, but to others it may have meant good-bye, and those of us who have been privileged to live in hawaii understand aloha means i love you. as someone who has been privileged to live in hawaii, i know that he embodied the very best of that spirit.
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the very best of aloha. it's fitting his last words danny spoke on this earth. he may have been saying good-bye to us, maybe hello to someone waiting on the other side, but it was a final expression most of all of his love for the family and friends that he caredded so -- cared so much about, about the men and women heavers honored to -- he was honored to serve with, and for the country that held such a special place in his heart so we remember a man who inspired all of us with his courage and moved us with his compassion, that inspired us with his integrity and who taught so many of us including a young boy growing up in hawaii
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that america has a place for everyone. may god bless daniel inouye, and may god grant us more souls like his. ♪
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